Health outcomes vary greatly between high-income and low-income countries. In low-income countries, life expectancy is relatively short due to issues like poor sanitation, malnutrition, and lack of medical resources. While some global health measures have improved, concerns remain regarding issues like high blood pressure, obesity, and maternal mortality. Within the United States, factors like age, sex, race, social class, and lifestyle all impact health and life expectancy. The country's for-profit healthcare system results in unequal access to medical care and high costs, though the Affordable Care Act aimed to expand coverage. Ongoing debates center around topics such as socialized vs direct-pay systems and new medical technologies.

1. Principles of Sociology 21
Health & Medicine

2. Health in Global Perspective
• Health in Low-Income Countries:
– Relatively short life expectancy exists.
– Many die before reaching their teens.
– Poor sanitation, malnutrition, and unsafe water, and lack of
medical personnel contribute to poor health outcomes.
• Health in High-Income Countries:
– By the early 20th century, death rates from infectious
diseases had fallen sharply.
– Now chronic illnesses cause most deaths, usually in old age.

3. Health in Global Perspective
• Some progress has been made in life expectancy over the past 20 years,
often measured by the child survival rate = the number of children
surviving past their fifth birthday.
• Several global concerns remain:
– High blood pressure is growing worse in some nations.
– The global problem of obesity has doubled.
– Women continue to face a 15x greater chance of maternal death in low-
income nations.
– There remains a lack of funds to pay for decent healthcare.
• Capitalistic processes continue to pose an obstacle to low-income
nations obtaining advanced medical technology and name-brand drugs
that are necessary.

5. Health in the United States
• social epidemiology = the study of the causes and
distribution of health, disease, and impairment in a
population.
– Age: disease and death rates are highest among the
youngest and the elderly (65+).
• chronic diseases = long-term illnesses present from birth or
developing gradually.
• acute diseases = sudden diseases with dramatic effects on
health, sometimes causing sudden death.
• However, young people die much less frequently than in
previous eras.

6. Health in the United States
• social epidemiology (cont’d):
– Sex: contemporary women live longer than men due to
both medical advancements (limiting maternal deaths)
and certain aspects of gender socialization (making life
more dangerous for men).
– Nevertheless, women still suffer more chronic diseases
than men later in life.
– Males are socialized to be more aggressive and
individualistic–contributes to their higher rates of
accidents, violence, and suicide.

7. Health in the United States
• social epidemiology (cont’d):
– Race/Ethnicity: average life expectancy rates are
different across race/ethnicity:
• African Americans (lowest)
• whites (middle)
• Hispanic (high)
• Asian (highest)
• Culturally, diets and habits (including varying levels of
stress) make different racial/ethnic groups more
susceptible to certain conditions and diseases.

8. Health in the United States
• social epidemiology (cont’d):
– Social Class: both income and the type of neighborhood
one lives in can affect life expectancy.
• This is probably related to the extent which a neighborhood
offers safety, peace, and accessible healthier options.
• Also, many lower-income jobs feature less healthy work
environments and more exposure to harmful factors.
• Higher income and wealth boosts health: better nutrition and
health care, as well as safer and less stressful surroundings.
• Infant mortality is twice as high for severely disadvantaged
children as for children born into privileged families.

9. Health in the United States
• Lifestyle Factors:
– Alcohol: heavy drinking can lead to numerous problems.
• binge drinking = men consuming 5+ drinks within a short period, or
women consuming 4+ in a short period.
• Short-term effects: compromised judgment in driving, sexual encounters,
or other behaviors.
• Long-term effects: brain damage, nutritional deficiencies, heart problems,
damage to the liver.
– Nicotine (Tobacco):
• About 450,000 people die each year from problems related to smoking or
environmental tobacco smoke (= second-hand smoke).
• Smoking has fallen in popularity over the last thirty years due to raised
awareness of health risks.

10. Health in the United States
• Lifestyle Factors (cont’d):
– Illegal Drugs:
• Marijuana is the most popular illegal drug used in the U.S.
• In 2014, Colorado and Washington became the first states to allow the
sale of recreational marijuana (though, technically, not its public use).
• Federal law still prohibits recreational use of marijuana, but the Justice
Department has decided not to challenge state legalization.
• Research (NIH) has found that heavy use of marijuana can significantly
diminish IQ levels, and there may be some increased cancer risks due
to deeper inhalation.
• Cocaine is another popular drug that can be inhaled, injected, or
smoked (“crack”) – long-term use carries risks of heart disease, stroke,
and neurological disorders.

11. Health in the United States
• Lifestyle Factors (cont’d):
– Eating Disorders: physical and mental disorder that
involves intense dieting or other unhealthy method
of weight control driven by the desire to be very thin.
• Anorexia Nervosa
– Characterized by dieting to the point of starvation.
– College-age women believe that “guys like thin girls.”
• Bulimia
– Involves binge eating followed by induced vomiting to avoid
weight gain.

12. Health in the United States
• Lifestyle Factors (cont’d):
– Sexually Transmitted Diseases:
• There are about 20 million new STD infections each year, with the most
common being chlamydia (especially among women).
• Both gonorrhea and syphilis are curable, but can cause significant damage
if undiagnosed – some populations and regions are more at risk than
others.
• AIDS, first identified in 1981, is caused by HIV and decreases the body’s
ability to fight diseases.
• HIV is the world’s leading infectious killer, with many unaware that they
have the virus.
• Antiretroviral Therapy (ART) has managed to slow the progression of the
HIV/AIDS epidemic during the past 10 years.

15. Health in the United States
• Lifestyle Factors (cont’d):
– Staying Healthy:
• The lifestyle choices we make also include positive choices
based on the improved information we now have.
• More people are changing their dietary habits and engaging in
regular exercise.
• However, Americans still have a long way to go: the American
diet is still high in fats and sugars, and low in fruits and
vegetables – a way of eating that can reduce life expectancy by
2-5 years.
• Over a third of Americans struggle with obesity, and many more
are overweight – body types that can lead to serious health
risks: hypertension, Type 2 Diabetes, and cancer.

16. Health Care in the U.S.: History
• Pre-1900:
– Medicine was viewed more as an “art” than a science.
– The U.S. was full of self-described “doctors” and quasi-doctors who
received various “credentials” from a variety of sources.
• Early 20th Century:
– With scientific discoveries, medicine began to be taken more
seriously and prominent medical schools began to develop.
– The Flexner Report: In 1910, the way in which medical schools
should be run was standardized as a result of Flexner’s study.
• Unfortunately, one result of this was to shut out women and racial
minorities – until the 1960s-1970s, nearly all doctors were white males
from the upper classes.

17. Health Care in the U.S.: History
• The Professionalization of Medicine:
– Physicians were now trained in the specialized knowledge of medicine that
was both theoretical and professional.
– Physicians became autonomous, relying on their own professional
judgment and expecting their patients to respect that judgment.
– Doctors are self-regulating, having their own boards and associations for
licensing and accreditation.
– Physicians expect compliance from patients concerning their advice and
prices they charge, given their professional authority.
– Doctors practice altruism by going beyond their own self-interest in serving
others.
• Licensed medical doctors gained control over the medical
establishment, a situation that continues today.

18. Health Care in the U.S.: Today
• American health care has always been on a fee-
for-service basis, expensive since there were few
restrictions on medical pricing.
– POSITIVE: In our capitalistic economy, competition in
the medical field has motivated advances in medicine
and quality health care.
– NEGATIVE: The resulting quality health care cannot
be afforded by many citizens, resulting in inequality
in one of the most basic areas of life.

19. Paying for Health Care: The U.S.
• The Affordable Care Act of 2010
– Created a new insurance marketplace designed to
make health care insurance more affordable.
– Set forth several stages of health care reform to be
implemented from 2010-2019, culminating in a
universal health care system.
– 2012: one aspect of the plan, requiring people to
purchase insurance or face a penalty, was challenged
in the Supreme Court, which upheld the plan.

20. The Debate: Two Types of Healthcare
• Socialized Medicine
–Medical care system in which the government
owns and operates most medical facilities and
employs most physicians.
• Direct-Fee System
–Medical care system in which patients pay
directly for the services of physicians and
hospitals.

21. Medical Technology: Social Effects
1. Advanced technologies create options for people
and for society, but these options alter human
relationships.
 Such technology has extended life, but can also perpetuate
“life” in the absence of consciousness and force hard decisions
on families, especially when there is no living will.
2. Advanced technologies increase the cost of medical
care.
 Machines like CAT scanners and MRI equipment typically cost
over $1 million each, which means that all hospitals cannot
have them – buying such technology takes money from other
health programs that could benefit more people.

22. Medical Technology: Social Effects
3. Advanced technologies such as cloning and
stem cell research raise controversial questions
about the very nature of life.
 Is it possible to clone a human being?
 If so, would it be ethical to do so?
 Is it ethical to destroy embryos to get stem cells?
 Is it possible to do viable stem cell research without
destroying human embryos?

23. Holistic & Alternative Medicine
• holistic medicine = a more recent approach to health care that
emphasizes prevention and focuses on treating the whole
person rather than just symptoms.
• Holistic methods are popular with those practicing alternative
medicine = healing methods outside of conventional,
mainstream medicine.
– Economic competition comes into play as the medical establishment has a
vested interest in keeping patient money in mainstream treatments.
– In recent years, several alternative methods have been reluctantly
embraced by mainstream medical practitioners due to popularity with
patients.

25. Theory: Structural-Functionalist
• Role Analysis (Parsons): People must be healthy if
society is to remain stable – thus, sickness is viewed as a
form of deviancy that must be socially controlled.
• sick role = a set of norms and expectations considered
appropriate for those defined as “sick.”
 Sick people are not responsible for their condition.
 People who assume the sick role are temporarily exempt from
their normal obligations (EX: school; work).
 People who are sick must want to get well.
 People who are sick must seek competent help from a medical
professional.

26. Theory: Structural-Functionalist
• Illness is seen as dysfunctional for both the individual
and for society, since the sick person is unable to fulfill
their social role.
• The specialized knowledge of Physicians qualifies them
to be certified by society as the “gatekeepers” of the
sick role – it is they who decide when a patient enters
into, and exits, the role.
– Patients are subordinate to the doctors, and are expected to
take their proper place by following their “doctor’s orders”
and re-entering society as a “well” person as soon as possible.

27. Theory: Social-Conflict
• Problems in U.S. health care are rooted in
capitalism, which views medicine as a commodity.
• The medical-industrial complex = the entire
medical industry – from local to global levels –
that maintains economic dominance.
• Physicians most benefit from the U.S. system
since they have held a virtual monopoly over
medicine.

28. Theory: Symbolic Interactionist
• Concepts like “health” and “illness” are socially
constructed – that is, we attach meanings to these ideas
and they, in turn, affect our self-concepts and
relationships in society.
• For instance, the social definition of a disease can create
stigmatization of those who have the disease, which in
turn makes those who don’t have it feel better about
themselves (EX: cancer/smoking; AIDS/promiscuity).
• While illnesses often have objective criteria, symbolic
interactionists highlight the importance of recognizing
the subjective elements that factor into our
interpretations of health and illness.

29. Theory: Symbolic Interactionist
• medicalization = process where problems are redefined and treated
as illnesses or disorders.
– conceptual = the use of medical terminology to define the problem.
– institutional = physicians act as gatekeepers for treatment.
– interactional = physicians treat patient conditions as medical
problems.
• medicalization of deviance = deviant behaviors like gambling are
defined as ‘disease’ or ‘syndromes’, etc.
• demedicalization = process where a problem ceases to be defined as
an illness or a disorder.

30. Theory: Postmodernist
• Foucault (1963) believed that medical “truth” is a social
construction defined by doctors, who maintain power through the
clinical gaze (their overseeing of patients coupled with speaking
“wisely”).
• This gives physicians an air of superiority that becomes further
enhanced by their specialized systems of classification and
invasive techniques (patient nakedness; probing; testing body
fluids).
– In this way, a myth of “diagnostic wisdom” was created and
the doctor’s medical dominance became well established.
• Foucault has been criticized for treating patients as mere passive
victims.

31. Mental Illness
• mental disorder = a condition making it impossible for a
person to cope with daily life.
• mental illness = severe mental disorder requiring
medication, psychotherapy, or possibly hospitalization.
– Each year, about 5% of the adult population (over 11 million
people) of the U.S. has serious mental illness.
• 17th and 18th centuries: the “insane” came to be viewed
as a dangerous minority and asylums began to be
constructed to treat them.

32. Mental Illness
• deinstitutionalization = patients being rapidly
discharged from mental hospitals.
– This became a movement in the 1960s due to new drug
treatments and protests against asylums as violating patient
rights.
– However, many critics have emerged who argue that this has
simply aggravated the problem of inadequate care for the
mentally ill.
• Although involuntary commitment is controversial, it
remains the primary way that agents of social control
deal with those regarded as mentally ill and dangerous.

33. Disability
• disability = physical or mental impairment that significantly
limits a person in life that may result in stigmatization or
discrimination.
• The term “disability” is somewhat relative, since it involves
factors like disabling environments, social attitudes, and
how various communities regard the label as applied to
themselves.
• People typically respond to their disability either with
avoidance or vigilance.
• Because many of the disabled require adaptive devices, they
become easily objectified by the medical industry.